The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups

Abstract

Background: Questionnaires are widely used to assess the mental health status of refugees, whereas their construct validity largely remains unexplored. Objective: This study examined the construct validity of two widely-used instruments for the assessment of PTSD symptoms (Harvard Trauma Questionnaire [HTQ]; 16 items) and symptoms of anxiety and depression (Hopkins Symptom Check list-25 [HSCL-25]; 25 items) among Dutch and refugee patients with different linguistic backgrounds. Method: We applied exploratory factor analyses and measurement invariance analyses to test construct validity.Participants (n =1 256) were divided into five linguistic groups defined by language family, including four non-western linguistic groups (Indo-Iranian [n = 262], Niger-Congo [n = 134], Semitic [n = 288], and South Slavic languages [n = 199]) and one western linguistic group (Germanic languages; Dutch [n = 373]). Results: Exploratory factor analysis yielded a 3-factor structure of the HTQ and a 2-factor structure of the HSCL-25. Measurement invariance 20 analyses on the HTQ showed strong measurement invariance across the groups of refugee patients. However, Dutch patients reported milder symptom severity on most items of the HTQ. Measurement invariance analyses on the HSCL-25 (not conducted in Dutch patients) indicated partial strong measurement invariance across refugee patients. Conclusion: We conclude that mental health constructs measured by the HTQ and the HSCL25 25 are to a large extent interpreted in a similar way by refugee patients. This indicates that these instruments can be applied in non-western refugee patient populations, and that local idioms of distress and inherent response patterns may not play a major role when applying the HTQ and the HSCL-25 in these populations. Yet, whereas meaningful comparisons of observed PTSD and depression scores between groups of refugee patients with different non30 western linguistic background are feasible, comparisons between patients with a western and non-western linguistic background, as well as comparisons of anxiety scores, are likely to be biased. Future studies need to establish whether the commonly used cut-off scores of both questionnaires apply for refugee patients with non-western linguistic backgrounds.

Well‐Being and Posttraumatic Growth Among Syrian Refugees in Jordan

“…The Arabic version of the HTQ was previously used with Iraqi refugees (Shoeb et al., ), and was the basis for this study, with minor adjustments made for the context of the Syrian crisis. We used the first 16 trauma‐symptom items in the HTQ to assess PTSD symptom severity, as these items have been used with other refugees from different non‐Western linguistic populations (Fouchier et al., ; Ichikawa, Nakahara, & Wakai, ; Lhewa, Banu, Rosenfeld, & Keller, ; Wind, van der Aa, de la Rie, & Knipscheer, ). The HTQ total score is an average score, based on a range of responses from 1 ( not at all ) to 4 ( extremely ), with higher scores indicating an ascending level of PTSD symptom severity.…”

“…The HTQ total score is an average score, based on a range of responses from 1 ( not at all ) to 4 ( extremely ), with higher scores indicating an ascending level of PTSD symptom severity. Though there has been some dispute regarding the use of HTQ cutoff scores with different cultural groups (Rasmussen, Verkuilen, Ho, & Fan, ), a recent investigation of the factor structure and measurement invariance of the HTQ found that “…meaningful comparisons of observed PTSD scale scores on the HTQ between refugee patients with different non‐Western linguistic backgrounds can be made” (Wind et al., , p. 8). Reliability of the 16‐item HTQ in this study was Cronbach's α = .89.…”

Associations of neural processing of reward with posttraumatic stress disorder and secondary psychotic symptoms in trauma-affected refugees

“…From the HSCL-25, only the depression items (item 11-25) were used. HTQ and HSCL-25 are valid questionnaires to assess symptoms of PTSD, depression, and anxiety in trauma-affected refugees (Wind, van der Aa, de la Rie, & Knipscheer, 2017). All questionnaires were available in the participants' native language, and translators were accessible throughout the study.…”

Contextualizing Cognitions: the Relation Between Negative Post-traumatic Cognitions and Post-traumatic Stress Among Palestinian Refugees

“…The HTQ is a suitable screening tool for PTSD, with a cut-off score of 2.5 (e.g., Mollica et al 1992), based on the first 16 items of part 3, as an established cut-off for the DSM-IV PTSD diagnosis (Wind et al 2017). The instrument has proven to be valid and reliable (Mollica et al 2004).…”